Abortion

The information on this page is intended for health care providers and includes clinical guidance as well as tools and resources for practice and for patients.

Information

Safe abortion is essential health care and a human right. Unintended pregnancies are common and affect people of all backgrounds around the world.

An abortion is one of the most common health care needs in Canada. It has been estimated that one in three Canadian women will have an abortion during their lifetime. Canada has limited information on how many trans and non-binary people access abortion services, but we do know that they do.

Health care providers (including obstetrician-gynaecologists, family physicians, and nurses) play an essential role in providing and supporting patients who need abortion care in Canada.

Even though abortion is legal, it may not be available or accessible.

Types of Abortion

There are two types of abortion to consider: medication abortion and procedural abortion. Medication abortion is the process by which a pregnancy is interrupted by taking medicine. Procedural abortion is done in a hospital or clinic and is a minor medical procedure to end a pregnancy, the most common method being vacuum aspiration.

Medication abortion regimens are equivalent to early procedural abortion in terms of safety, efficacy, and retreatment rates. The decision between medication abortion and procedural abortion requires an understanding of both options, and a review of factors that affect method selection.

Medication Abortion

Overall, abortion rates have not increased in Canada since the introduction of the medicine for abortion (Mifegymiso) but since then, the majority of the abortions have shifted from procedural to medication. The number of medication abortion providers has also increased significantly across specialties and providers, including nurses and midwives under medical directive.

Medication abortion is indicated by Health Canada for pregnancy termination up to 63 days as counted from the first day of the last menstrual period (LMP) in a presumed 28-day cycle. The Society of Obstetricians and Gynaecologists of Canada (SOGC) indicates safe use of medication abortion up to 70 days LMP. There is no absolute lower gestational age limit.

Medication abortion presents an opportunity to mitigate some of the logistical challenges for accessing abortion services. The pandemic increased the provision of virtual-care abortions, and low-contact, no-contact, and self-managed abortions have become increasingly available. However, most medication abortions in Canada are still provided through in-person consultation and assessment.

Medication abortion is suitable for patients who:

Prefer a non-invasive method
Prefer to have an abortion in the comfort of their home
Have the confidence of being able to manage the process and side effects at home
Able to take one to three days off work or other responsibilities to undergo the abortion process
Lack means of transportation to travel to the clinic for a procedural abortion (but still need access to emergency services in event of complications)

Contraindications for medication abortions include:

Ectopic pregnancy
Chronic adrenal failure
Inherited porphyria
Uncontrolled asthma
Hemorrhagic disorder or concurrent anticoagulant therapy
Anemia (Hb level < 95 g/L)
Long-term systemic corticosteroid therapy
Hypersensitivity to mifepristone or misoprostol
Intrauterine device in situ (no longer a contraindication once removed)

Serious systemic illnesses such as liver disease, cardiac disease, renal failure, and seizure disorders (these illnesses should be evaluated individually)

Procedural Abortion

First trimester (7 to <14 weeks) procedural abortion is one of the most common and safe surgical procedures performed in Canada, with a risk of serious complications under 0.2%. Use of a no-touch technique and antibiotic prophylaxis reduce the risk of infection. Second trimester procedural abortion (≥14 weeks) is safe when performed by trained clinicians., although when compared with first trimester procedures, second trimester procedural abortion is associated with more complications, which increase with advancing gestational age.

Procedural abortion is suitable for patients who:

Prefer to have in-person support and monitoring from health care professionals at a clinic or a hospital
Want to have the abortion completed quickly to return to work or other responsibilities
Are comfortable with the use of medical instruments and internal exams
Are comfortable undergoing local or general anesthesia to manage pain
Do not want to disclose the pregnancy and the abortion to those the patients live with (such as partners, roommates, co-workers), as it might be difficult to conceal heavy bleeding and strong cramps

Abortion Resources for Health Care Providers

The SOGC provides a list of resources for health care providers who want to provide or refer their patients for abortion care. On this page, links to resources are also provided for health care providers to support diverse patients seeking an abortion, including resources for providing trauma-informed, gender-informed, and culturally safe care. Resources that are helpful to patients are also included.